444 - Development and Validation of a Novel Observational Checklist for Assessing Pediatric Residents' Engagement with Social Determinants of Health

Publication Number: 444.4214

Tai Hairston, Johns Hopkins Children's Center, Baltimore, MD, United States; Carly Byrd, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Nicole A. Shilkofski, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Jawaria Khan, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Emily Murphy, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Suzanne Mead, Johns Hopkins Children's Center, severna park, MD, United States; Nakiya Showell, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Marquita Genies, Johns Hopkins Children's Center, Baltmore, MD, United States

Background: Addressing social determinants of health (SDOH) is a core competency for graduating pediatric residents, yet validated tools to objectively assess engagement with SDOH in clinical practice are limited. To address this gap, we developed a novel observational checklist that enables structured, real-time evaluation of resident behavior in discussing and addressing SDOH during inpatient clinical rounds.

Objective: To create and establish content validity for an observational checklist designed to assess pediatric residents' identification of and intervention for SDOH in clinical settings.

Design/Methods: Checklist items were developed based on the Centers for Medicare & Medicaid Services domains of SDOH. To establish content validity, we employed a Modified Delphi approach, assembling a panel of seven health equity and education experts, including hospital medicine faculty, residency program leadership, and nursing staff. In the first round, panelists rated each item on a 5-point Likert scale for clarity and relevance and provided open-ended feedback. Items with less than 80% agreement in either category were removed, while items scoring between 80–90% were revised. Open-ended feedback was discussed in a group forum, where modifications were agreed upon to enhance clarity and specificity. In the second Delphi round, each item achieved >80% agreement, with additional phrasing adjustments to further refine clarity.

Results: After two Delphi rounds, the checklist achieved full consensus, with all items rated above 80% in clarity and relevance. The final checklist was piloted across 20 inpatient observations of patient encounters, with two raters assessing each encounter. Inter-rater reliability was high, with a 95% agreement rate, indicating strong internal structure validity and usability in a clinical setting.

Conclusion(s): This validated checklist provides a practical, reliable tool for assessing pediatric resident engagement with SDOH during clinical rounds. The Modified Delphi process was successful in refining checklist items to achieve expert consensus, achieving high relevance and clarity for each item. This checklist supports objective assessment of health equity competencies in residency training and has potential for broader application in residency programs focused on the integration of health equity metrics into clinical practice.